Provider Demographics
NPI:1437925625
Name:URQUHART, AMANDA JEAN (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:URQUHART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 COUNTY ROAD 3750
Mailing Address - Street 2:
Mailing Address - City:HAWKINS
Mailing Address - State:TX
Mailing Address - Zip Code:75765-5602
Mailing Address - Country:US
Mailing Address - Phone:571-643-8796
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2146441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant